. The diagnosis of diseases of women . nusual is the primary descent of theposterior vaginal wall. A limited degree of descensus vaginse mayexist without displacing the uterus. The descent occurs frombelow upward; seldom from above downward (Fig. 74). 2. Prolapsus vaginae implies a protrusion of the vaginal wallsbeyond the vulvar outlet, and is always associated with downwarddisplacement of the uterus. In primary descent and prolapse ofthe uterus the vaginal walls are inverted from above downward,there being no pouching of the vaginal walls as in secondary pro-lapse of the uterus. The lower se
. The diagnosis of diseases of women . nusual is the primary descent of theposterior vaginal wall. A limited degree of descensus vaginse mayexist without displacing the uterus. The descent occurs frombelow upward; seldom from above downward (Fig. 74). 2. Prolapsus vaginae implies a protrusion of the vaginal wallsbeyond the vulvar outlet, and is always associated with downwarddisplacement of the uterus. In primary descent and prolapse ofthe uterus the vaginal walls are inverted from above downward,there being no pouching of the vaginal walls as in secondary pro-lapse of the uterus. The lower segment of the vaginal wall mayprolapse, the upper segment invert, and the intervening one remainunchanged. The prolapsed anterior vaginal wall pouches into thevagina, dragging the bladder with it, and forming what is knownas a cystocele. The bladder is intimately attached to the anteriorwall of the vagina, so that it is quite impossible for the vagina todescend without carrying the bladder with it. The vaginal wall PLATE XXVII. FIG. Secondary prolapsus uteri >A^itlT elongation of the cervix. Both,vaginal avails are completely inverted. The cervix protrudes from,the vulva. JSTeither the bladder nor the rectum are found in the pro-truding structures. FIG. 2.
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